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Childhood Obesity: More Fruit, Vegetables and Milk May not be the Answer

The EU is about to inject some more cash into healthy school food programmes, and while this may be good news in terms of stimulating falling dairy and produce sales, the limitations of promoting healthy choices in order to combat childhood obesity are becoming ever more clear. For instance, a recent study supported by the US Centers for Disease Control and Prevention indicates that the common-sense assumption that “good food drives out the bad” may be a fallacy. A policy rethink involving closer coordination between the home and the school environment may be required, though this will be difficult to achieve in practice.

EU grants extra funding for fresh produce and dairy promotion

In January 2016, the European Parliament decided to grant an extra €20 million annually to promote healthy eating amongst children, raising the amount spent on pushing the consumption of fruit, vegetables and milk in schools to €250 million per year.

Milk sales are flagging across Europe, so the region’s dairy players are bound to welcome this boost. Our packaged food data shows that, over the 2009-2015 review period, total volume sales of milk (excluding flavoured milk drinks) declined by 11% in Italy, by 10% in Ireland, Spain and Portugal, and by 8% in France and the Netherlands.

But perhaps even more worrying from a public health perspective is that sales of fruit and vegetables are also ailing. Our fresh food data shows that per capita volumes of fresh fruit and vegetables shifted through retail outlets, consumer foodservice outlets and institutions (including schools) declined by 2% in Western Europe over the 2010-2015 review period. Across Eastern Europe, per capita volumes of fresh fruits plummeted by 20% and fresh vegetables – by 4% over the same period.

Among the EU markets with the most pronounced declines in per capita volumes of both fresh fruit and vegetables were Italy, Spain and the UK. In Italy, per capita sales of fresh fruit fell from 95.3kg in 2010 to 88.8 kg in 2015 and fresh vegetables from 64.9kg to 61kg.

The European Parliament’s policy with regards to how its allocated funds are to be used seems quite clear: local, fresh produce distributed to schools have priorities over processed food, with a particular focus on under-consumed categories. Items with added sugar, salt and fat will only be permitted in cases where this is justifiable. For example, products such as chocolate milk and yoghurt with fruit may still be eligible, but the EU will only contribute funding to these if the milk component makes up at least 90% of the product (75% in exceptional cases), as long as it also meets the established standards with regards to sugar, fat and salt content.

The final version of the European Parliament’s new funding measures and guidelines is expected to be published in around April this year.

Children who eat healthy food still eat the bad stuff

The allocation of extra funds with the objective of making children’s diets healthier is certainly encouraging. But will it help to resolve one of Europe’s most pertinent public health problems that is childhood obesity? According to the EU Action Plan on Childhood Obesity 2014-2020, one in three 6-9-year-olds is obese in the EU.

There is the widespread assumption that, when children integrate healthier food into their diet, their intake of energy-dense processed (“junk”) food decreases. A paper published in December 2015 in the Maternal and Child Health Journal, however, calls this expectation into question.

Researchers from Ohio State University studied the eating habits of 357 pre-school children in low-income neighbourhoods in Columbus, expecting children who frequently consumed healthy food (like fruit, vegetables and milk) to have a lower intake of unhealthy food choices than those who did not.

To the researchers’ surprise, there was no such correlation. Contrary to their expectations, the study revealed that children whose diets regularly featured healthy elements were, in fact, just as likely to consume sweetened drinks, fast food, confectionery and salty snacks than any of the other children involved in the study.

This research was part of a US Centers for Disease Control and Prevention project, and a larger-scale study is already in the works. If it yields similar results, then it could well effect a paradigm shift among policy makers.

Coordination between school and home environments tricky to achieve

In a nutshell, if “good” does not automatically replace “bad”, then much more effort will have to be expended on keeping energy-dense low-nutrient foods out of children’s reach, which is a tricky undertaking in markets where these products are abundant.

The fact that such products are already restricted in the school environment in many countries may lull parents into a false sense of security. They may be too permissive with treat foods at home, since their children “already eat healthy at school”.

The problem (besides children’s love for sweet and fatty snacks, etc) is that the human stomach is elastic in design and that is very easy to overeat by several hundred calories a day. In the long run, a daily chocolate bar may mean the difference between a lean child and a podgy one, and the apple eaten during morning break at school is not going to magically cancel out half a packet of cookies devoured in the afternoon. On the contrary: the apple may be the “extra” calories a child would not normally consume.

Schools, even with strengthening financial support, can only do so much. The truth is that we simply do not yet know all there is to know about the complex dynamics surrounding food choices. Children move through several different environments during the day where caregivers may unwittingly be pulling at opposite ends of the rope rather than in a common direction.